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Myocardial Infarction Stabilization

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242. Canadian guidelines on opioid use disorder among older adults

are detrimental, including nausea and vomiting, constipation, sedation, mood changes, myocardial infarction, immunosuppression, and trauma, the latter of which includes falls, fractures, and motor vehicle accidents . Other harmful effects of opioids include hormone suppression leading to sexual dysfunction and osteoporosis, dry mouth leading to tooth decay, respiratory depression leading to sleep apnea and/or overdose (sometimes fatal), and addiction (Baldini et al ., 2012) . Most clinicians are aware (...) patient as an individual . Tapering opioids in older adults with pain (and without an OUD) may offer the advantage of increased cognitive alertness and lower the risk of potential adverse outcomes (e .g ., falls, myocardial infarction, sleep apnea, overdose,) . However, tapering opioids can also pose some risks if done inappropriately . Too great or too frequent a dose drop or abrupt cessation can lead to overwhelming withdrawal symptoms including pain, anxiety, insomnia, lowering of mood (including

2019 CPG Infobase

243. Canadian Cardiovascular Society/Canadian Heart Failure Society Joint Position Statement on the Evaluation and Management of Patients With Cardiac Amyloidosis (Full text)

. Fontana M. Gilbertson J.A. et al. Occult transthyretin cardiac amyloid in severe calcific aortic stenosis: prevalence and prognosis in patients undergoing surgical aortic valve replacement. Circ Cardiovasc Imaging. 2016; 9 ( e005066 ) Amyloid deposits around coronary microvasculature can lead to angina or rarely myocardial infarction in the absence of epicardial coronary artery disease. shows a summary of important cardiovascular manifestations of cardiac amyloidosis. Figure 1 Cardiovascular (...) -photon emission computed tomography can also help differentiate the regional myocardial uptake seen in patients with a history of myocardial infarction from the diffuse myocardial uptake typical of ATTR, improving diagnostic accuracy in this setting. Dorbala S. Ando Y. Bokhari S. et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: part 1 of 2-evidence base and standardized methods of imaging. J Nucl Cardiol. 2019; 26 : 2065

2020 Canadian Cardiovascular Society PubMed abstract

244. Guidelines on Chronic Coronary Syndromes (Full text)

tomography-based fractional flow reserve GEMINI- ACS A Study to Compare the Safety of Rivaroxaban Versus Acetylsalicylic Acid in Addition to Either Clopidogrel or Ticagrelor Therapy in Participants With Acute Coronary Syndrome GFR Glomerular filtration rate GLS Global longitudinal strain GOSPEL Global secondary prevention strategies to limit event recurrence after myocardial infarction HbA1c Glycated haemoglobin HF Heart failure ICA Invasive coronary angiography IMR Index of microcirculatory resistance (...) IMT Intima−media thickness IONA Impact Of Nicorandil in Angina iwFR Instantaneous wave-free ratio (instant flow reserve) LAD Left anterior descending LBBB Left bundle branch block LDL-C Low-density lipoprotein cholesterol LM Left main (coronary artery) LV Left ventricular LVEF Left ventricular ejection fraction MI Myocardial infarction MRA Mineralocorticoid receptor antagonist NOAC Non-vitamin K antagonist oral anticoagulant NT-proBNP N-terminal pro-B-type natriuretic peptide OAC Oral

2019 European Society of Cardiology PubMed abstract

245. Guidelines on Supraventricular Tachycardia (for the management of patients with) (Full text)

JET Junctional ectopic tachycardia LA Left atrial/atrium LAL Left anterolateral LBBB Left bundle branch block LL Left lateral LP Left posterior LPL Left posterolateral LPS Left posteroseptal LV Left ventricle/ventricular MI Myocardial infarction MRAT Macro−re-entrant atrial tachycardia MS Mid-septal NT-proBNP N-terminal pro-B-type natriuretic peptide PJRT Permanent junctional reciprocating tachycardia p.o. Per os (by mouth) POTS Postural orthostatic tachycardia syndrome PPM Permanent pacemaker (...) %. The overall incidence of atrial flutter is 88/100 000 person-years in the US population annually. Adjusted for age, the incidence of atrial flutter in men (125/100 000) is >2.5 times that of women (59/100 000) and increases exponentially with age. Patients with atrial flutter are more likely to have been smokers, have a longer PR interval, history of myocardial infarction (MI), and history of heart failure (HF). Catheter ablation is now used extensively for most varieties of SVT, and patient-reported

2019 European Society of Cardiology PubMed abstract

246. Diagnosis and Management of Acute Pulmonary Embolism (Full text)

considerations 3.1 Epidemiology Venous thromboembolism (VTE), clinically presenting as DVT or PE, is globally the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke. In epidemiological studies, annual incidence rates for PE range from 39–115 per 100 000 population; for DVT, incidence rates range from 53–162 per 100 000 population. , Cross-sectional data show that the incidence of VTE is almost eight times higher in individuals aged ≥80 years than in the fifth decade (...) limb Hospitalization for heart failure or atrial fibrillation/flutter (within previous 3 months) Hip or knee replacement Major trauma Myocardial infarction (within previous 3 months) Previous VTE Spinal cord injury Moderate risk factors (OR 2–9) Arthroscopic knee surgery Autoimmune diseases Blood transfusion Central venous lines Intravenous catheters and leads Chemotherapy Congestive heart failure or respiratory failure Erythropoiesis-stimulating agents Hormone replacement therapy (depends

2019 European Society of Cardiology PubMed abstract

247. Management of Dyslipidaemias (Full text)

Reduction LPL Lipoprotein lipase Lp(a) Lipoprotein(a) mAb Monoclonal antibody MACE Major adverse cardiovascular events MESA Multi-Ethnic Study of Atherosclerosis MetS Metabolic syndrome MI Myocardial infarction mRNA Messenger RNA MTP Microsomal triglyceride transfer protein NAFLD Non-alcoholic fatty liver disease NNT Number needed to treat NPC1L1 Niemann-Pick C1-like protein 1 NSTE-ACS Non-ST elevation acute coronary syndrome o.d. Once a day (omni die) ODYSSEY Outcomes Evaluation of Cardiovascular (...) SFA Saturated fatty acid SHARP Study of Heart and Renal Protection siRNA Small interfering RNA SMI Severe mental illness SPARCL Stroke Prevention by Aggressive Reduction in Cholesterol Levels STAREE STAtin Therapy for Reducing Events in the Elderly STEMI ST-elevation myocardial infarction STRENGTH Outcomes Study to Assess STatin Residual Risk Reduction with EpaNova in HiGh CV Risk PatienTs with Hypertriglyceridemia TC Total cholesterol T1DM Type 1 diabetes mellitus T2DM Type 2 diabetes mellitus

2019 European Society of Cardiology PubMed abstract

248. Guidelines on Diabetes, Pre-Diabetes and Cardiovascular Diseases developed in collaboration with the EASD (Full text)

A Diabetes Outcome Progression Trial AF Atrial fibrillation ARB Angiotensin receptor blocker ART Arterial Revascularization Trial ASCEND A Study of Cardiovascular Events iN Diabetes ASCVD Atherosclerotic cardiovascular disease ATLAS-ACS TIMI 51 Anti-Xa Therapy to Lower cardiovascular events in Addition to Standard therapy in subjects with Acute Coronary Syndromes - Thrombolysis In Myocardial Infarction 51 BARI 2D Bypass Angioplasty Revascularization Investigation 2 Diabetes BEST Randomized Comparison (...) DECLARE- TIMI 58 Dapagliflozin Effect on Cardiovascular Events−Thrombolysis In Myocardial Infarction 58 trial DES Drug-eluting stent DEVOTE Trial Comparing Cardiovascular Safety of Insulin Degludec versus Insulin Glargine in Patients with Type 2 Diabetes at High Risk of cardiovascular Events DIAD Detection of Ischaemia in Asymptomatic Diabetics DIGAMI Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction DiRECT Diabetes Remission Clinical Trial DM Diabetes mellitus DPP4 Dipeptidyl

2019 European Society of Cardiology PubMed abstract

250. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association (Full text)

time to the specific diagnosis of the cause of FM that may have a specific treatment. , AMI indicates acute myocardial infarction; EMB, endomyocardial biopsy; FM, fulminant myocarditis; LFT, liver function test; and VBG, venous blood gas. Once properly stabilized, regardless of pathogenesis, all patients with FM and contractile dysfunction benefit from evidence-based neurohormonal antagonist therapy. Heart failure therapy with neurohormonal antagonists and diuretics is the cornerstone of management (...) into account at least 2 of 3 CMR tissue characterization criteria for myocarditis (79% diagnostic accuracy ): (1) edema (as quantified by global or regional T2 enhancement), (2) scar or active inflammation (by LGE imaging, usually in a regional or global subepicardial distribution, although subendocardial infarct LGE has been observed ; ), or (3) evidence of myocardial hyperemia (by enhancement early after gadolinium). , The sensitivity may change with clinical severity, with the greatest sensitivity

2020 American Heart Association PubMed abstract

251. Delivering novel therapies in the 21st century

-tumour activity and the efficacy of PD-L1 therapies. CASE STUDY 2 CASE STUDY 3 Novel treatments for chronic heart failure Modified mRNA therapies can help tissue to regenerate after injury. mRNA expressing the VEGF protein is injected directly into damaged cardiac muscle tissue where it is taken up by cells to make new proteins. A single administration improves cardiac function, repairs heart damage, and regenerates blood vessels including arteries two months after myocardial infarction in animal (...) models. Meanwhile, transplanting embryonic-stem cell derived human ventricular progenitor cells has been shown to preserve cardiac function in mouse studies following myocardial infarction. This could be combined with CRISPR genome editing to engineer progenitor cells with wider applications. Anticalin protein for respiratory disease Anticalin® proteins are smaller than antibodies, and so can be delivered into the body by inhalation. AstraZeneca is using Pieris’ Anticalin® protein platform to create

2019 Academy of Medical Sciences

253. Perioperative

undergoing noncardiac surgery. (Fleisher , 2014) Risk calculators may include the Revised Cardiac Risk Index, American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Myocardial Infarction and Cardiac Arrest (MICA), and American College of Surgeons NSQIP Surgical Risk Calculator. (Fleisher, 2014) Return to Index Table Return to Table of Contents Electrocardiogram Cardiac arrhythmias and conduction disturbances are common findings in the perioperative period. However, limited (...) including 371,594 patients with anemia found that Return to Index Table Return to Table of Contents Institute for Clinical Systems Improvement 18 Perioperative Sixth Edition /January 2020 anemia was associated with increased mortality, acute kidney injury, infection and increased incidence of red cell transfusion in anemic patients undergoing noncardiac or cardiac surgeries. In cardiac surgery, anemia was associated with increased risk for stroke but not myocardial infarction

2020 Institute for Clinical Systems Improvement

255. Venous Thromboembolism (VTE)

thrombocytopenia (for heparin or LMWH administration) Underlying liver disorder (INR > 1.5) Clinically unstable pulmonary embolus: • hypotension (systolic bp 220 mm Hg and/or diastolic BP > 120 mm Hg) Renal insufficiency (serum creatinine > 2.5 mg dL) Morbid obesity (BMI>40) Comorbidity that might increase the risk of home treatment (congestive heart failure, COPD, diabetes, cancer, recent myocardial infarction or stroke, altered mental status, age>70, or any other condition increasing risk to the patient (...) ]. Treatment Heparin Low molecular weight heparin (LMWH). LMWH is preferred for initial treatment over unfractionated heparin (UFH) or fondaparinux due to better safety and outcomes [IA]. Outpatient use of LMWH for DVT. LMWH is appropriate for most patients with DVT to use at home [IIA]. Some require initial brief hospital admission and stabilization. Clinically stable patients not at elevated risk due to comorbidities can be managed entirely as outpatients using LMWH. Unfractionated heparin. UFH

2020 University of Michigan Health System

256. Heart Failure - Systolic Dysfunction

implantation an ICD include: • An ICD should not be implanted within one month following myocardial infarction or within three months following CABG (data from CABG Patch (1997) and DINAMIT (2004)). • Survival benefit is only realized after one year (MADIT II and SCD HeFT trials), so the patient’s life expectancy should be greater than a year. • Women meeting criteria for ICD placement should be referred to an electrophysiologist or cardiologist no differently than men. However, some question exists (...) . The agents were tested in different populations, spironolactone in patients with severe heart failure and eplerenone in patients with mild heart failure and in patients post- myocardial infarction. As aldosterone antagonists, both spironolactone and eplerenone are potassium sparing diuretics and can cause hyperkalemia, especially when administered concomitantly with angiotensin converting enzyme inhibitors or angiotensin receptor blockers. In the clinical trial of aldosterone antagonism in patients

2020 University of Michigan Health System

258. Crizanlizumab, Voxelotor, and L-Glutamine for Sickle Cell Disease: Effectiveness and Value

complications and comorbidities MI Myocardial Infarction NICE National Institute for Health and Care Excellence No. Number NS Not significant NR Not reported PICOTS Population, Interventions, Comparisons, Outcomes, Timing, Setting, and Study Design PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses QALY Quality-adjusted life year QOL Quality of life RCT Randomized controlled trial SAE Serious adverse event SCD Sickle cell disease SF-36 36-Item Short Form Survey TEAE Treatment-emergent (...) by the FDA on November 15, 2019 to reduce the frequency of vaso-occlusive crises in adults and pediatric patients ages 16 years and older with SCD. Voxelotor (Global Blood Therapeutics, Inc.) is an HbS polymerization inhibitor that reversibly binds to hemoglobin to stabilize the oxygenated hemoglobin state, thus shifting the oxyhemoglobin dissociation curve. 11 Voxelotor was approved by the FDA on November 25, 2019 for the treatment of SCD in adults and pediatric patients 12 years of age and older. ©

2020 California Technology Assessment Forum

259. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group

Downloaded from by Karen Karen Sparkes on 03/26/2020no effects on mortality (n = 3 studies; RR, 1.02 [CI, 0.68 to 1.54]) or myocardial infarction risk (n = 2 studies; RR, 0.96 [CI, 0.51 to 1.81]). No studies were found that assessed ASA in com- bination with other antiplatelet drugs, such as prasug- rel or ticagrelor. The evidence was downgraded for high or unclear risk of bias in the Chinese studies and for serious indirectness in all 4 trials (most patients did not have a history (...) therapy. Although various adverse events have been re- ported with PPI therapy (statement E5), the systematic review and meta-analysis conducted for this guideline found no increased risk for myocardial infarction in pa- tients receiving DAPT. On the basis of the evidence, the consensus group suggests PPI therapy to prevent rebleeding in most pa- tients who require single- or dual-antiplatelet therapy for a duration consistent with the ongoing need for an- tiplatelet therapy. StatementE5 In patients

2020 Canadian Association of Gastroenterology

260. Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation

; ICD = implantable cardioverter-defibrillator; JVD = jugular vein distention; LV = left ventricle; LVESD = left 37 ventricular end-systolic diameter; MDT = multidisciplinary team; MI = myocardial infarction; MR = mitral regurgitation; MRA = magnetic resonance angiogram; NYHA = New York Heart Association; PA = pulmonary artery; PASP = pulmonary artery systolic pressure; TEE = transesophageal echocardiogram; TTE = transthoracic echocardiogram Consideration of local HF and/or EP cardiology (...) . Chronic, severe, primary MR imposes a pure volume overload on the LV, resulting in eccentric hypertrophy and LV dilation. Increased preload, combined with low-to-normal afterload, augments LV ejection fraction (EF), which is typically supranormal. As the LV dilates, LV wall stress increases. Incipient and irreversible myocardial dysfunction may occur with longstanding LV volume overload. Because EF is a load-dependent measure of LV systolic function, it can be preserved even as myocardial contractile

2020 American College of Cardiology

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